内镜下经鼻腔-蝶窦入路垂体腺瘤切除术

目的将"内镜下经鼻腔-蝶窦入路垂体腺瘤切除术”这一微创手术加以介绍并就相关问题进行探讨.方法采用直径4mm的0.、30°硬性鼻内镜及配套摄像系统、内镜冲水系统、鼻窦钳等设备,内镜下切除垂体腺瘤30例,其中泌乳素腺瘤12例,生长激素腺瘤2例,无功能腺瘤16例,微腺瘤1例,复发垂体腺瘤1例.结果内镜下全切肿瘤27例,近全切肿瘤3例,术后2例一过性脑脊液鼻漏,1例丘脑出血.术后13例内分泌化验恢复正常.术后3～8个月随访14例,1例复发,无鼻中隔穿孔、萎缩性鼻炎等并发症.结论内镜下经鼻腔-蝶窦入路垂体腺瘤切除术深部照明好,切除肿瘤彻底,鼻腔结构损伤小.随着设备的进一步完善和经验的不断提高,该术式将会越来越多地得以应用并取得良好效果.

Endonasal transsphenoidal endoscopic pituitary surgery

Objective To introduce an minimally invasive neurosurgical operation and discuss relative problems. Methods This study focuse on 30 patients with pituitary adenomas. 1 patient had microadenomas, 29 had macroadenomas. 14 patients had hormone secreting adenomas (2 with growth hormone secreting adenomas and 12 with prolactinomas), 16 had nonsecreting adenomas, 1 had recurrent adenoma. Operations were performed through a nostril using rigid zero and thirty degree rigid endoscopes. Results 27 underwent total resection and 3 subtotal resection. Among the 14 patients with hormone secreting adenomas, 13 got recovery on hormone level. 2 had transient cerebrospinal rhinorrhea which recovered within one week postoperatively. with 3 to 8 months follow up on 13 patients, there was one recurred case. But no lip numbness, septal perforations and atrophic rhinitis. Conclusions Endoscope hypophysectomy offers an increased illumination and magnification during operation, as well as less injury of nasal structures. The improvement of instrumentation and operation skills will facilitate this surgery.